A recent study by Erika J. Wolf, PhD, and Principal Investigator Mark W. Miller, PhD, both from the National Center for PTSD at the VA Boston Healthcare System and Department of Psychiatry at Boston University School of Medicine (BUSM), found an association between posttraumatic stress disorder (PTSD) and dissociation. The results were published in the Archives of General Psychiatry.

The findings suggest that symptoms of dissociation, which reflect problems in consciousness and awareness, are a prominent feature of PTSD in a distinct subtype of individuals with the disorder. The relationship of dissociation and PTSD is controversial, but important for accurately classifying PTSD and better understanding its course.

The researchers studied PTSD and dissociative symptoms in 492 veterans and their intimate partners, all of whom had histories of trauma. Participants reported exposure to a variety of traumatic events including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents and natural disasters with most participants reporting exposure to multiple types of traumatic events.

In the study, participants were interviewed by clinicians using the Clinician Administered PTSD Scale (CAPS), a diagnostic instrument that measures the frequency and severity of PTSD and dissociation symptoms. Analysis revealed a small but distinct subset of participants characterized by high symptoms of dissociation and PTSD along with high rates of sexual assault history.

This study contributes to a growing body of research, providing a basis for adding the new dissociative subtype distinction to the PTSD diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

“This study helps to identify a small group of individuals who show a unique pattern of post-traumatic symptoms marked by derealization, or feeling that one’s surroundings are unreal or unfamiliar, and depersonalization, or feeling that one’s body is unfamiliar or strange,” said Wolf. “The results clarify that these symptoms are not a core part of PTSD for most people with the disorder. However, identification of this group of individuals is important for maximizing PTSD treatment effectiveness.”